Local health officer may declare HIV, hepatitis C epidemic in Clark County

“There is at least indirect evidence that there is a problem,” he said.

Burke told a group of residents who meet to discuss drug addiction in Clark County that recent data shows local elevated rates for the diseases. In 2014, Clark County’s rate of new HIV cases was about 37.5 percent higher than Indiana’s average. Clark County had 11 people per 100,000 with HIV, whereas Indiana had 8.

And Clark County’s new cases of hepatitis C were 40.5 percent higher than the state’s average in 2014 — 97 in Clark per 100,000 compared to 69 for Indiana.

Indiana Senate Enrolled Act 461 passed in May authorizes counties to implement a one-year syringe exchange program, or SEP, with state approval in cases of hepatitis C or HIV epidemics where the mode of transmission is intravenous drug use.

“One of the things I’ve been grappling with is, how much of a problem is IV drug use in Clark County?” Burke told the meeting’s participants Thursday at St. Paul’s Episcopal Church in Jeffersonville.

He estimates the county has somewhere around 5,000 IV drug users.

The number of Clark County overdose deaths — some from heroin — has risen in recent years.

In 2013, Clark County had 30 overdose deaths with four resulting from heroin. That number increased to 53 in 2014, with three deaths from heroin. By the end of May 2015, 23 had died of overdose deaths already. These numbers do not include deaths by suicide.

But no reliable statistics for the number of IV drug users in the county exist, Burke said, which is why he’s pitching it as a pilot program.

“I don’t know how well it’s going to be utilized,” he said after the meeting.

He said the local health department would likely gauge the success of the program after four or six months.

LOGISTICS

Research proves that needle exchanges decrease the incidence of HIV and hepatitis C, produce improved life expectancy and health conditions and don’t increase IV drug use, Burke said. It also produces cost savings for the state.

In neighboring Scott County, where there have been 170 HIV positive cases since December, someone infected with both HIV and hepatitis C will likely cost $1 million to treat over their 25-year life expectancy. That compares to less than $100,000 for the average healthy Hoosier over the same time period, Burke said.

“Indiana can’t afford not to stop this disease, in Clark County as well,” he said.

The SEP guidelines for local health departments stipulates four steps in implementing such a program.

First, the local health officer — Burke, in this case — must declare there is an HIV and/or hepatitis C epidemic, that the primary mode of transmission is intravenous drug use and that an SEP is the medically appropriate response.

Next, the Clark County Commissioners must conduct a public hearing and vote to adopt the declaration. If adopted, the commissioners would then notify Indiana Health Commissioner Dr. Jerome Adams. It would then be up to Adams and other state officials whether to approve the SEP.

Scott and Madison counties have been the only two in the state to request a needle exchange program, and both have been approved, according to Indiana State Department of Health spokeswoman Amanda Turney.

Burke said he plans to speak to the commissioners next week in preparation of possibly declaring an epidemic.

“That’s sort of the easy part, I guess,” Burke said. “The devil is in the details of how we set this up.”

The Clark County Health Department is “very tight on funds” after responding to Scott County’s HIV and hepatitis C epidemic and to the recent tuberculosis outbreak in Sellersburg, so Burke said the exchange will need to be hosted in another location.

Lori Harris, CEO of Family Health Centers of Southern Indiana, said in an email that some of the federally qualified health center’s grants prohibit it from hosting an SEP. Harris added that the center does have a limited number of needle bleaching kits to hand out.

Some of the group members tossed around other ideas at Thursday’s meeting, such as finding a church to host the program. Burke said the syringes would need to be securely stored in a separate location every night.

“Mobile units are good because you can go to different neighborhoods,” suggested Jeffersonville resident Carolyn King, who has been involved in Scott County’s response.

“The portable idea sounds like a good one but there’s logistics,” Burke responded, mentioning insurance and vehicle costs.

Because the law comes with no attached funds, the exchange would need to be staffed with trained volunteers who don’t necessarily have to be health professionals. Burke said there are two national organizations that would likely donate the syringes.

The law also requires that the SEP provides “an entry point for substance abuse treatment and care and other resources as appropriate to the individual.” Examples include providing access to behavioral health services, having health officials to assist with insurance enrolling and providing HIV and Hepatitis C education outreach.

Burke said the research on needle exchange programs shows increased rates of entry into drug rehabilitation programs because of the resources offered at the exchanges.

Many Scott County residents were at first skeptical of the program, believing it was a set-up to lure drug offenders for arrests.

“It’s tricky but it’s been very successful,” King said. “We’ve gotten a lot of people treatment in Scott County.”

LifeSpring Health Systems, a community mental health and substance abuse treatment center, played a role in Scott County’s HIV epidemic response. The center covers six counties, including Scott and Clark, and sent representatives to Scott County’s SEP to provide education materials and help enroll residents in treatment and counseling.

“We’re still working closely with the Scott County Health Department,” said Beth Keeney, vice president of development and grants of LifeSpring.

Keeney said that she isn’t sure if LifeSpring would be involved in a Clark County SEP but is interested in any type of collaborative effort.

She said she couldn’t speak on behalf of LifeSpring regarding its stance on needle exchanges.

“I will say in general we’re supportive of any evidence based practice shown to reduce substance abuse,” Keeney said.

LOOKING AHEAD

Clark County Commissioner Rick Stephenson said he would “definitely” consider voting for a syringe exchange program locally if Burke makes a declaration.

“We rely on Dr. Burke for all of the professional health business,” Stephenson said. “Yes, if he feels that is necessary, then I have a duty to do whatever I can to assist.”

Clark County Commissioner Bryan Glover also said he would have to defer to Burke’s recommendations.

“I think as long as he could back up his case with facts and statistics that show that we do have an increasing rate, then yes ... obviously we would have to address it.”

If approved for Clark County, law enforcement officers could not arrest someone for possession of syringes as long as they have their needle exchange identification card, likened to a prescription.

Clark County Sheriff Jamey Noel said an SEP likely wouldn’t affect enforcement too much “because generally for the most part, sometimes people will have a syringe and they’ll also have drugs in their possession too.”

“Fundamentally, the issue of why it’s so tough sometimes to combat the drug problem is because unfortunately, sometimes the most successful drug dealers are not users,” Noel said. “So basically they’re making their money and profit living off people that are addicted.”

He said when it comes to officer discretion, the sheriff’s department is targeting dealers to reach the “root of the problem.”

Noel has already outfitted patrol cars with sharps containers that officers can use to dispose dirty syringes found on the ground.

“ ... Since I’ve been sheriff in the last several months it seems to be a few more [discarded syringes] than what there normally would be,” he said.

Noel said a needle exchange program is not the only component in combating drug use and the spread HIV and hepatitis C.

“It’s an all-hands-on-deck approach is what it’s going to take because it’s not just about the enforcement effort of it,” he said. “It’s about getting the folks help.”

Burke thanked community members for coming together in an effort to curb drug use and the spread of disease through support of a possible needle exchange program.

“We also realize that it’s going to be controversial, that some people won’t support it, but that hasn’t stopped us in the past when we’ve made some difficult decisions and it’s not going to stop us this time,” he said.